This report originally appeared in the September 2009 issue of DOTmed Business News

Health care in the U.S. represents about one-sixth of the economy and a strong source of job growth in a tight labor market. But it's a "careful-what-you-wish-for" bright spot in a slow economy. By all indications, filling tomorrow's needs for health care professionals will be a great challenge for the nation's hospitals and other health care providers.

The clarion example is the anticipated shortage of primary care physicians. It is accepted wisdom that to rein in health care costs patients need a "quarterback" to coordinate their care, particularly in chronic disease prevention and management. Chronic diseases account for 70% of all deaths in the United States and the care costs for people with chronic diseases account for more than 75% of the nation's $2 trillion medical care costs, according to the Center for Disease Control (CDC).

The American College of Physicians warned in 2006 that primary care was on the verge of collapse and more recently reported on how little has been done about it. "The United States has yet to implement comprehensive strategies to recognize, support and enhance primary care to the degree necessary to reverse a worsening primary care shortage," states the ACP in a recent white paper: How Is a Shortage of Primary Care Physicians Affecting the Quality and Cost of Medical Care?

Today, physicians represent about a 60/40 split between specialists and primary care doctors, an imbalance brought about by higher pay incentives to enter specialties. Specialists earn about twice the pay of general practitioners according to the Bureau of Labor Statistics (BLS.gov). Heavy medical school debt causes a disproportionate number of M.D.s to pursue specialties.

Why should hospitals or medical facility administrators care about this? After all, they aren't in the business of providing primary care. Yet, the burden of the uninsured, combined with America's primary care crisis has transplanted primary care to tertiary care facilities. As the ACP white paper documents, patients living in areas with primary care shortages are at higher risk for preventable hospitalizations.

Meanwhile, we can't lose sight of shortages in medical specialties.

"Physician shortages extend far beyond primary care and have already been reported in 19 specialties as varied as emergency care, general surgery and child and adolescent psychiatry," J. James Rohack, M.D., President, American Medical Association, indicated in a recent letter to the Dallas Morning News. Dr. Rohack recommended increased funding for the National Health Service Corps to address the primary care problem. He also wants to lift the cap on government-funded medical residency slots. "We must seize this opportunity for comprehensive health reform to ensure there are enough physicians to care for all of America's patients," he noted.

Great Jobs Outlook

The primary care crisis is the elephant in the room when discussing health care staffing. However, other clinical and technical professionals are also vital to operational success at hospitals and other facilities.

According to the recent report by the president's Council of Economic Advisors, the long-term trend shows increasing prospects in the health care field, including the occupations of medical records and health information technicians, registered nurses, clinical laboratory technicians and physical therapists. The subsectors of nursing homes, physician offices and hospitals should also continue to grow. Home health care, outpatient care and medical and diagnostic laboratories are some of the subsectors expected to add the most jobs. (See DM9635.)

The health care field is a great place to be employed. Education and health services, taken together in government data, is an industry supersector projected to grow 18.8% by 2016, and add more jobs, nearly 5.5 million, than any other industry supersector. More than three out of every ten new jobs created in the U.S. economy will be in either the health care and social assistance, or public and private educational services sectors.

Health care and social assistance-including public and private hospitals, nursing and residential care facilities, and individual and family services-will grow by 25.4% and add 4 million new jobs, according to the Department of Labor's Tomorrow's Jobs report. Employment growth will be driven by increasing demand for health care because of an aging population and longer life expectancies.

Nursing Shortage Eases, Temporarily

Nursing remains at the center of health care provision in many settings and the shortage persists. While the economic downturn has motivated many retired nurses to return to the field, as reported in Health Affairs in June, the problem is not over. In 2007 and 2008 the ranks of America's nurses grew by about a quarter million. That's a relief, but this injection of talent won't be enough to address a long-term nursing deficit that will be caused by retiring baby boomers, according to the study's authors.

While the seminal BLS data was compiled before the recent recession, it reflects the intractability of the nursing shortage well into the future. We will need 587,000 more nurses by 2016, a 23.5% increase in a decade. That is not counting those positions that need replacing due to retirement. So while the recent swelling of the nursing ranks from a poor economy has slowed the demand a bit, overall, the nursing crisis continues not only because the professionals are aging, but because the patient base is also aging and will demand more care.

The American Association of Colleges of Nursing has neatly summarized the ongoing trouble that is the cause and effect of the nursing shortage. For instance, insufficient staffing makes the job more stressful for nurses in the workplace and drives many out of the profession. The AACN also documents that a high nurse turnover and vacancy rates are affecting access and quality of health care for patients. Nursing school enrollment is not growing fast enough to meet the demand for RNs and lack of faculty is part of the vicious cycle.

On a positive note for nurses and other practitioners, the federal economic stimulus package earmarks $200 million to support training programs for health care professionals, including $80.2 million for scholarships and loans; $39 million will be earmarked for nurses and nurse faculty, and $47.6 for primary care, among many other endowments. Also, the American Nurses Association is re-launching its Nurses Career Center, now a part of the National Healthcare Career Network (NHCN), a health care association job board network. (See DM 9873.)

Biomedical Engineering Moving In-House

The U.S. Department of Labor's Bureau of Labor Statistics projects a 21% increase in biomedical engineer employment through 2016, which is much faster than average growth compared to other occupations. More anecdotally, DOTmed's community of biomedical service and support companies reports an overall trend toward bringing medical equipment service in house at U.S. hospitals.

"There is no question that hospital systems are taking on more accountability for managing equipment and resources," said Rob Piconi, President and Chief Executive Officer, ReMedpar. "The pendulum is swinging toward an in-house trend. People are saying we can do equipment maintenance and repair more cheaply by bringing this inhouse and getting off some of the expensive service agreements."

The trend suggests that biomedical engineers will be highly sought by hospitals in the near future. Apart from reducing costs, another objective for in-sourcing is to improve repair service response. Conversely, challenges to in-sourcing include technical staff and education, managing and monitoring equipment performance, and finding parts.

"As administrators look to effect these strategies toward moving service in-house, they have to be cognizant of the skill-base within the hospital to do maintenance service agreements on machines, which requires ongoing capabilities training," Piconi said.

According to the Department of Labor, as biomedical engineering grows as a field, the education requirements are also increasing. Because of the intensifying interest in this field, the number of degrees granted in biomedical engineering has increased greatly. Biomedical engineers, particularly those with only a bachelor's degree, may face competition for their jobs. Unlike many other engineering specialties, a graduate degree is recommended, or required, for many entry-level jobs in this field, according to the Occupational Outlook Handbook.

Interestingly, the states with the highest concentration of biomedical engineers are California, Massachusetts, Minnesota, Maryland and Utah.

Help Wanted: Technologists, Technicians and Therapists

A heartbeat away from the essential care of clinicians is the contribution of medical technologists, technicians and therapists. Specialists in a number of job categories are experiencing increased demand for their services (see chart).

As a snapshot of the demand/supply balance, it's helpful to look at results from a 2009 survey of U.S. radiology facilities. Results from a Nationwide Survey of Radiation Therapy Facility Managers and Directors conducted by the American Society of Radiologic Technologists show that respondents estimate 7.6% of all FTEs (full-time equivalent positions) budgeted for radiation therapists are currently vacant and recruiting, 8.2% of dosimetrist positions, 12.1% of medical physicist positions, 9.2% of radiation oncologist positions, 7.1% of nursing positions, 6.1% of ancillary staff positions, as well as 10.2% of administrative staff. Note that only 18% of respondents indicated they have experienced consequences of a workforce shortage at their facility. However, an overall greater difficulty was reported in recruiting radiation therapists since last year.




In addition to techs, medical assistants' ranks will grow. For instance, the broad category of medical assistants (35.4% job growth) was the fastest-growing occupation in DOTmed's BLS data dip of selected jobs. Other future needs will be great for physical therapist assistants (32.4%) and physician assistants (27%).

In another trend, as the needs of researchers and patients increase, additional professional certifications are being created helping variety of health occupations to grow. For example, a comprehensive education and training program has been introduced by RadMD, LLC for professionals in medical imaging for pharmaceutical, medical device and biotech clinical trials (DM 9868).

For ongoing coverage of trends and opportunities in the health professions, visit www.dotmed.com/careers.